Add Modifiers

A Modifier can be added to a service through the Service Billing Profile. However, standalone services with more than one billing profile may require a claim rule to ensure the correct modifier is applied. 

Workflow

Let's review how to add a modifier to a claim with a claim rule!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Line Item Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Institutional or Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, under Behaviors, click Add Modifier.
  8. Enter the modifier(s) in the text box.
     
  9. Click Save to complete the process.
      

Box Number

• UB-04: Box 44 - HCPCS/Rate/HIPPS Code
• CMS-1500: Box 24d - Procedures, Services, or Suppliers

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.